BronchiectasisBronchiectasis

Dilated airways with frequently Dilated airways with frequently thickened wallsthickened walls

Bronchiectasis: ClinicalBronchiectasis: Clinical

Note: Bronchiectasis may happen 2/2 COPD or may be a Note: Bronchiectasis may happen 2/2 COPD or may be a separate process with very similar symptomsseparate process with very similar symptoms

Clinical:Clinical: Cough (90 %)Cough (90 %) Daily sputum production (76%)Daily sputum production (76%) Dyspnea (72%)Dyspnea (72%) Hemoptysis (56%)Hemoptysis (56%) Recurrent pleurisy Recurrent pleurisy

PathophysiologyPathophysiology

2 Prerequisites:2 Prerequisites:

Infectious insultInfectious insult

Impairment of drainage, airway Impairment of drainage, airway obstruction, and/or a defect in host obstruction, and/or a defect in host defense. defense.

Pathophys ContinuedPathophys Continued

Infection: Infection: Bacterial, mycobacterial, esp. ABPABacterial, mycobacterial, esp. ABPA central airway central airway

bronchiectasisbronchiectasis

Airway obstruction: Airway obstruction: intraluminal tumor, foreign body, lymph nodes, COPDintraluminal tumor, foreign body, lymph nodes, COPD

Immunodeficiency:Immunodeficiency: ciliary dyskinesia, HIV, hypogammaglobulinemia, cystic ciliary dyskinesia, HIV, hypogammaglobulinemia, cystic

fibrosis (obstruction and immunodef.)fibrosis (obstruction and immunodef.)

Note: this table compares primary bronchiectasis with COPDNote: this table compares primary bronchiectasis with COPD

Characteristic central bronchiectasis 2/2 ABPA

Note characteristic location in the upper lobes and superior segments of lower lobes

ExacerbationExacerbation

Exacerbation: Etiology +RxExacerbation: Etiology +RxColonization/infection: Colonization/infection: HemophilusHemophilus PseudomonasPseudomonas MAIMAI AspergillusAspergillus

Very difficult to distinguish colonization from acute infection with Very difficult to distinguish colonization from acute infection with these bugs.these bugs.

Psuedomonas colonized Psuedomonas colonized more bronchiectasis on CT; increased more bronchiectasis on CT; increased number of hospitalizations vs H. flu colonizationnumber of hospitalizations vs H. flu colonization

Effect of sputum bacteriology on the quality of life of patients with bronchiectasisEffect of sputum bacteriology on the quality of life of patients with bronchiectasis. . Wilson CB; Jones PW; O'Leary CJ; Hansell DM; Cole PJ; Wilson CB; Jones PW; O'Leary CJ; Hansell DM; Cole PJ;

Wilson R Eur Respir J 1997 Aug;10(8):1754-60Wilson R Eur Respir J 1997 Aug;10(8):1754-60. .

Treatment: Treatment: fluoroquinolonefluoroquinolone

PreventionPrevention

Antibiotics-Controversial:Antibiotics-Controversial:Consider Macrolide TIWConsider Macrolide TIWCipro qd X 7-14 D/ monthCipro qd X 7-14 D/ month

Bronchial Hygiene, physiotherapy, Bronchial Hygiene, physiotherapy, pulmonary rehabpulmonary rehab

?bronchodilators, and steroids?bronchodilators, and steroids SurgerySurgery

CitationsCitations

All material from Uptodate.com unless All material from Uptodate.com unless otherwise notedotherwise noted